Abstract
BackgroundRecent observational studies have focused on lithium treatment in the elderly, with particular reference to safety in terms of thyroid and renal functions. The purpose of this study was to compare the clinical characteristics of patients starting lithium treatment before (N = 79) or after (N = 31) the age of 65 years. Patients were followed up for 6 years with focus on renal function and prescription of levothyroxine and methimazole.ResultsAt baseline, median lithium serum concentration was 0.55 mmol/l. The estimated glomerular filtration rate was lower than 60 ml/min/1.73 m2 in 43 (39%) patients. In a multiple regression analysis controlling for age and gender, we found a significant effect of duration of lithium treatment on estimated glomerular filtration rate (−0.85 ml/min/1.73 m2 per year of prior exposure). The annual decline during follow-up was 2.3 ml/min/1.73 m2. Two patients were prescribed levothyroxine, and two were prescribed methimazole for the first time during follow-up.Conclusions Median lithium serum concentration in this cohort of elderly patients with mainly bipolar disorders was lower than the therapeutic range indicated for younger adults. The decline in glomerular filtration rate may be accelerated by long-term lithium use. Thyroid and renal functions continue to require close monitoring throughout the course of lithium treatment.Trial registration NP/2013/3836. Registered 24 June 2013
Highlights
Recent observational studies have focused on lithium treatment in the elderly, with particular reference to safety in terms of thyroid and renal functions
Our therapeutic range for lithium maintenance in elderly patients is widened to 0.40–0.80 mmol/l compared to the 0.60–0.80 mmol/l range indicated for younger adults
Dosing and maintenance of serum concentrations Maintenance doses in this elderly cohort were much lower compared to the usual dosage of 900–1500 mg of lithium carbonate per day used in younger adults (Baldessarini and Tarazi 2006)
Summary
Recent observational studies have focused on lithium treatment in the elderly, with particular reference to safety in terms of thyroid and renal functions. The purpose of this study was to compare the clinical characteristics of patients starting lithium treatment before (N = 79) or after (N = 31) the age of 65 years. Reviews published over the last two decades continue to recommend lithium treatment in elderly patients with bipolar disorder (Young et al 2004; Aziz et al 2006; Shulman 2010). Kraszewska et al (2015) studied thyroid function in a cross-sectional sample of 66 patients with bipolar disorder receiving lithium over a period of between 10 and 44 years (mean age = 62 years). Some features of hypothyroidism occurred in 22% of their female sample
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